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Abstract

This article reviews the traumatic impact of Hurricane Katrina on the children of New Orleans. After describing the events comprising the trauma, it reviews the historical context of hurricanes in New Orleans and the social and political challenges that affected the area's response. It then considers the consequences of Hurricane Katrina in terms of disruption of services and governmental and nongovernmental responses to the psychologic needs created by the storm. The authors review preliminary studies about the affects of the hurricane on children and adolescents and conclude with a consideration of the lessons learned from both practice and policy perspectives.

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... Drury and colleagues (15) note that following the Katrina disaster, the Federal government allocated a large amount of funds (over 40 million dollars) to Louisiana for disaster related mental health response through the Federal Emergency Management Agency (FEMA); however, despite the funds they were not allocated to provide increased treatment services for individuals or to expand the training of clinicians in evidence-based approaches. Drury and colleagues argue that this is because the Stafford Disaster Relief and Emergency Assistance Act, which provides for federal assistance describes the mental health response as "crisis counseling". ...
... The Substance Abuse and Mental Health Services Administration (SAMHSA) manages this FEMA mental health component and interprets the Stafford Act to mean that FEMA funds after disasters cannot be used for comprehensive mental health treatment. The SAMHSA Crisis Counseling Program is therefore not mental health treatment; it is intended to be very short-term (1 to 5 sessions) and is generally provided by non-licensed lay persons (15). For those who need treatment, the crisis counseling can function as a referral program; however, this is problematic if the community has few treatment providers in place in the immediate aftermath or traditional community services PTSD Chronicity 5 have been disrupted so that there is no one left to refer people to. ...
... Katrina (1,5) and insightful policy analysis (15,16) highlights the need to develop a more responsive allocation of disaster funds to help reduce the mental health burden in disaster exposed communities and the time may be ripe for such reform (17). While the federal government does allocate long term funding of mental health services for the underserved via programs like Medicaid for the poor and Medicare for the elderly and disabled, policy analysis of the Katrina disaster also has highlighted the failure of intergovernmental communication (18,19,20) and so funding that goes from the federal government, to the states, then on down to local governments and finally to mental health care providers may fail to reach those in need. ...
Article
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Recent findings showing chronic post-traumatic stress disorder and other mental health symptoms in individuals exposed to Hurricane Katrina cogently argues for changes in the federal funding of mental health following disasters. This commentary discusses the evidence for protracted high rates of mental health problems in both adults and children following Katrina. The limitations to current mental health funding legislation post-disaster are noted, and initial suggestions for additional disaster-related mental health funding programs are made.
... Consistent with these national trends, surveys of adults residing in the Gulf region in the early months following Katrina indicated that ethnic minorities perceived more discrimination than nonminorities and that regardless of ethnicity individuals living in New Orleans perceived less social support and perceived more discrimination than those living along the Gulf Coast of Mississippi (Weems et al. 2007b). An additional broad influence that is important to note is the state and federal government response and the laws and policies that govern funding the mental health response (Drury et al. 2008). A final potential influence worth noting at the macrosystem level is television viewing in a culture of continuous news cycles. ...
... Funding large scale implementation of similar programs in areas hard hit by disaster may help reduce the mental health burden on youth reducing rates of PTSD and fostering symptom decline. Drury, Scheeringa, and Zeanah (2008) have provided an insightful review the federal laws governing the distribution of funds for mental services following disaster. Drury et al. (2008) note that following the Katrina disaster, the Federal government allocated a large amount of funds (over 40 million dollars) to Louisiana for disaster related mental health response through the Federal Emergency Management Agency (FEMA); however, despite the funds they were not allocated to provide increased treatment services for individuals or to expand the training of clinicians in evidence-based approaches. ...
... Drury, Scheeringa, and Zeanah (2008) have provided an insightful review the federal laws governing the distribution of funds for mental services following disaster. Drury et al. (2008) note that following the Katrina disaster, the Federal government allocated a large amount of funds (over 40 million dollars) to Louisiana for disaster related mental health response through the Federal Emergency Management Agency (FEMA); however, despite the funds they were not allocated to provide increased treatment services for individuals or to expand the training of clinicians in evidence-based approaches. Drury et al. argue that this is because the Stafford Disaster Relief and Emergency Assistance Act, which provides for federal assistance, describes the mental health response as "crisis counseling". ...
Article
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This study examined the stability of post traumatic stress disorder (PTSD) symptoms in a predominantly ethnic minority sample of youth exposed to Hurricane Katrina. Youth (n = 191 grades 4th thru 8th) were screened for exposure to traumatic experiences and PTSD symptoms at 24 months (Time 1) and then again at 30 months (Time 2) post-disaster. PTSD symptoms did not significantly decline over time and were higher than rates reported at earlier time points for more ethnically diverse samples. Younger age, female sex, and continued disrepair to the child’s home predicted stable elevated PTSD symptoms. Findings are consistent with predictions from contextual theories of disaster exposure and with epidemiological data from adult samples suggesting that the incidence of PTSD post Katrina is showing an atypical pattern of remittance. Theoretical, applied, and policy implications are discussed.
... support. An additional broad influence that is important to note is the state and federal government response and the laws and policies that govern funding the mental health response. Drury, Scheeringa, and Zeanah (2008) have provided an insightful review of the federal laws governing the distribution of funds for mental services following Katrina.Drury et al. (2008)note that following the Katrina disaster, the Federal government allocated a large amount of funds (over 40 million dollars) to Louisiana for disaster-related mental health response through the Federal Emergency Management Agency (FEMA); however, the funds were not allocated to provide increased treatment services for individuals or to e ...
... Drury, Scheeringa, and Zeanah (2008) have provided an insightful review of the federal laws governing the distribution of funds for mental services following Katrina.Drury et al. (2008)note that following the Katrina disaster, the Federal government allocated a large amount of funds (over 40 million dollars) to Louisiana for disaster-related mental health response through the Federal Emergency Management Agency (FEMA); however, the funds were not allocated to provide increased treatment services for individuals or to expand the training of clinicians in evidence-based approaches. TheDrury et al. (2008)policy analysis suggests that the reason for this was because the Stafford Disaster Relief and Emergency Assistance Act, which provides for federal assistance, describes the mental health response as " crisis counseling. " The Substance Abuse and Mental Health Services Administration (SAMHSA) manages this FEMA mental health component and interprets the Stafford Act to mean that FEMA funds after disasters cannot be used for comprehensive mental health treatment. ...
... " The Substance Abuse and Mental Health Services Administration (SAMHSA) manages this FEMA mental health component and interprets the Stafford Act to mean that FEMA funds after disasters cannot be used for comprehensive mental health treatment. The SAMHSA Crisis Counseling Program is not mental health treatment in this regard; it is intended to be very short term (1–5 sessions) and is generally provided by non-licensed lay persons (Drury et al., 2008). For those who need treatment, the crisis counseling can function as a referral program; however, this is problematic if the community has few treatment providers in place or these services have been disrupted so that there is no one left to refer people to. ...
Chapter
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This chapter reviews studies on the impact of natural disasters on childhood and adolescent emotional development with an emphasis on studies conducted with Hurricane Katrina samples. Special consideration is given to the role of exposure to disasters on adolescent emotional development. The findings are reviewed and presented within an integrative perspective (i.e., an ecological needs-based perspective) drawn from broad contextual theories of human development. The perspective emphasizes multiple levels of influence on emotional development through the interference of multiple human needs.
... Youth exposed to hurricane Katrina related traumatic stress, for example, have been shown to be at risk for long-term emotional problems . Hurricane effected areas often remain in clear need of mental health services for many years following the disaster (Drury, Scheeringa, & Zeanah, 2008;Weems, 2010), and in particular youth exposed to Hurricane Katrina, perhaps because contextual factors (e.g., damage and disrepair) contribute to PTSD symptom stability . Thus, initial support for the StArT manual may foster wider application and empirical tests of the intervention following future disasters. ...
... The apparent chronic nature of mental health problems following Katrina (Kessler et al., 2008;Weems et al., 2010) speak to the importance of long term community and also school based efforts to address the mental health needs of individuals following natural disaster that are ongoing and not just short-term immediately post-disaster (Drury et al., 2008;Weems, 2008). The StArT manual evaluated here has promising potential for underserved youth. ...
Article
Youth traumatized by natural disasters report high levels of posttraumatic stress such as symptoms of posttraumatic stress disorder, other anxiety disorders, and depression. Research suggests that cognitive behavioral therapies are promising interventions for symptom reduction; however, few cognitive behavioral treatments have been systematically tested in youth hurricane survivors. The current study provides an examination of the efficacy of an intervention manual designed specifically for hurricane-exposed youth (i.e., the StArT manual) using a partially nonconcurrent multiple baseline design. Youth ages 8-13 (n = 6) who met diagnostic criteria for posttraumatic stress disorder were provided the individual StArT treatment in their school. Youth were assessed at pretreatment, weekly during treatment, and at posttreatment. Results provide initial evidence for the efficacy of the StArT manual and suggest the feasibility of conducting the StArT manual in a school setting. The importance of large-scale tests of effectiveness and implementation of cognitive behavioral treatments in the wake of disaster among youth are discussed.
... New Orleans is notable for its strong culture of family and community ties, with Louisiana documenting the nation's highest rate of individuals residing in the state who were born in the state (U.S. Census Bureau, 2011). Community impacts from COVID-19 are also important to contextualize in light of disproportionately high rates of trauma exposure and lasting structural disenfranchisement secondary to Hurricane Katrina -another collective trauma marked by disruption of social connection and safety (Hawkins & Maurer, 2011) -as well as other syndemic and historical stressors, including racism-based stress, economic disparity, and violence (Drury et al., 2008). Digital connection provided a means of mitigating, but not replacing, lost social connection in the wake of Katrina (Shklovski et al., 2010). ...
... While there is movement toward including long-term ([6 months) prevention and mental health programming after a disaster, services are often geared toward interventions in the immediate aftermath. Although these crisis intervention services are essential for mitigating posttraumatic stress symptoms, they often focus on responses to the disaster itself (Drury, Scheeringa, & Zeanah, 2008). Longer-term interventions, however, generally focus on emotional responses associated with ongoing loss, disruption, and the recurring threat that the disaster may happen again (Natasi et al., 2011). ...
Article
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Disasters can affect a youth’s physical and emotional well-being. They disrupt everyday life by displacing individuals and families, destroying homes, and splintering communities (Gewirtz et al. in J Marital Fam Ther 34(2):177–192, 2008; La Greca and Silverman in Child Dev Perspect 3(1):4–10, 2009). School-based interventions are one approach to mitigate emotional distress in youth who have experienced a disaster, as schools are one of the most common venues for youth to receive mental health services (Greenberg et al. in Am Psychol 58:466–474, 2003). This paper explores the impact of a school-based psychosocial curriculum entitled Journey of Hope (JoH). This eight-session intervention attempts to reduce the impact of a disaster by enhancing protective factors such as social support, coping, and psycho-education. The evaluation study was conducted in the 2014–2015 school year after an EF5 tornado struck Moore, Oklahoma. As a result of the tornado, 24 people were killed, 377 injured, and two schools were destroyed (National Weather Service Weather Forecast Office, 2014). This mixed methods study employed quantitative and qualitative measures to examine the impact of the JoH intervention. Quantitative measures examined coping, general self-efficacy, prosocial behaviors, and overall distress. Qualitative data were obtained through interviews with N = 16 students after participation in the JoH. Semi-structured interview guides were used to determine what children learned, liked, and felt was beneficial from taking part in the JoH. A two-way repeated-measures ANOVA was used to assess the differences between the experimental and control group at baseline and posttest. Results indicated a significant increase in positive coping skills including communication and tension management and prosocial behaviors from baseline to posttest for the Journey of Hope group. No significant differences were found on self-efficacy or overall distress. Content analysis was conducted to determine qualitative results. Themes that emerged from the qualitative interviews suggested participation in the Journey of Hope enhanced peer relationships and helped participants identify how to manage emotions such as anger, anxiety, and grief. Findings from this evaluation study suggest that participation in a broadly accessible psycho-educational program may help children cope with traumatic events such as a natural disaster. Further research should be conducted to assess whether the Journey of Hope is transferrable across disaster contexts.
... [4][5][6][7] Similar findings were reported after Hurricane Katrina. [8][9][10][11] For example, Scheeringa and Zeanah 12 found high rates of PTSD in young children who did (43.5%) and did not (62.5%) ...
Article
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In September 2008, the Texas coast was directly hit by Hurricane Ike. Galveston Island was flooded by 4.25 m of storm surge, affecting most of the island's housing and infrastructure. The purpose of this study is to examine whether youth who did not evacuate (11 percent), and subsequently were exposed to Hurricane Ike, exhibit higher rates of substance use and physical and sexual teen dating violence (TDV; both perpetration and victimization) when compared with adolescents who did evacuate. Public high school in southeast Texas that was in the direct path of Hurricane Ike. An anonymous survey was conducted in March 2009 to 1,048 high school students who returned to the Galveston Island post-storm (41 percent Hispanic, 23 percent African American, and 27 percent White). Teen dating violence and substance use. Mantel-Haenszel odds ratios, adjusting for age and ethnicity, were computed. When compared with boys who evacuated, nonevacuating boys were more likely to perpetrate physical dating violence and sexual assault and to be a victim of sexual assault. Nonevacuating boys and girls were more likely to report recent use of excessive alcohol, marijuana, and cocaine than those who did evacuate. School personnel, medical personnel, and mental health service providers should consider screening for evacuation status in seeking to identify those adolescents who most need services after a natural disaster. In addition to addressing internalized emotions and psychological symptoms associated with experiencing trauma, intervention programs should focus on reducing externalized behavior such as substance use and TDV.
... As the efficacy and effectiveness of postdisaster treatments becomes more established, it will be critical for public policy to align with those findings so that resources are appropriately allocated to provide the best mental health services for children and adolescents. In the aftermath of a disaster, the federal dollars and volunteer assistance applied to mental health services are often designed to meet the immediate needs of a population in crisis (Weems & Overstreet, 2009), which is not necessarily conducive to a public health approach to mental health service delivery (Drury, Scheeringa, & Zeanah, 2008;Vernberg, 2002). There is little evidence that a short-term approach to mental health treatment works and it is clear there are long-term mental health needs in postdisaster environments (Kessler et al., 2008). ...
Article
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Natural disasters cause widespread destruction, economic loss, and death, leaving children to cope with the devastating aftermath. The research literature has demonstrated that children are at risk postdisaster for negative mental health outcomes, such as posttraumatic stress disorder and depression. The purpose of this review is to highlight the challenges associated with childhood exposure to severe natural disasters and to summarize the current research on clinical interventions for children postdisaster. Specific challenges reviewed include disaster-related deaths, secondary stressors typical in postdisaster environments, disruption in social networks, and the threat of recurrent disasters. A public health framework for school-based mental health services is discussed and the need for research on effective intervention models for youth in postdisaster environments is highlighted.
... Findings also have potential policy implications in terms of accurate estimation of services needed. Drury et al. (2008) have suggested that even though the federal government allocated a large amount of funding for disaster-related mental health response to Katrina through the Federal Emergency Management Association (FEMA), the funds were not effectively used to provide increased treatment services in the region or to expand the training of clinicians in evidence-based approaches. This is because the Stafford Disaster Relief and Emergency Assistance Act, which provided the federal assistance, delegated such funds for ''crisis counseling'' (i.e., shortterm services) instead of investing in mental health services or infrastructure (which have long-term implications). ...
Article
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Abstract Objective: Multiple trajectories of posttraumatic stress (PTS) symptoms are hypothesized following disaster in a number of theoretical perspectives. Increasingly, those with rapidly declining, transient, or stable low symptoms are defined as resilient. This article examines trajectories to understand acute reactions to disaster, and explores the need to define resilience as more than just symptom trajectories. Methods: An urban school-based sample of youth exposed to both hurricanes Katrina and Gustav (n=141; grades 4 through 8) were assessed for PTS symptoms at 12 months and 6 months pre-Gustav (Times 1 and 2); and then again at 1 month post-Gustav (Time 3). Results: Data indicated that there were significant decreases in mean PTS symptoms post-Gustav, but individual trajectories were identified consistent with theory. Whereas an ostensibly resilient group was identified (stable low symptoms), results suggest that the group was heterogeneous in terms of disaster experiences, and that those with low symptoms but relatively high Katrina disaster exposure had a unique coping style. Conclusions: Results provide prospective data to support theories of multiple trauma exposure trajectories, and highlight the importance of empirically identifying resilient youth in terms of both functioning and level of risk exposure in disaster samples. http://online.liebertpub.com/doi/abs/10.1089/cap.2013.0042
... Between 200 000 and 300 000 children were evacuated and relocated, temporarily or permanently. 140 Children displaced by Hurricane Katrina experienced an average of 3 moves per child. Some believe that a child needs 4 to 6 months for academic recovery after a move that results in a change in schools. ...
Article
Rising global temperature is causing major physical, chemical, and ecological changes across the planet. There is wide consensus among scientific organizations and climatologists that these broad effects, known as climate change, are the result of contemporary human activity. Climate change poses threats to human health, safety, and security. Children are uniquely vulnerable to these threats. The effects of climate change on child health include physical and psychological sequelae of weather disasters, increased heat stress, decreased air quality, altered disease patterns of some climate-sensitive infections, and food, water, and nutrient insecurity in vulnerable regions. Prompt implementation of mitigation and adaptation strategies will protect children against worsening of the problem and its associated health effects. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.
... Other studies provided evidence of inter-group aggression (Kemmelmeier, Broadus, & Padilla, 2008). African-Americans suffered the most in terms of distress factors related to the disaster (Lee, Shen, & Tran, in press), while adolescents exhibited posttraumatic stress and elevated aggression (Marsee, 2008), and children showed similar devastating psychological effects (Drury, Scheeringa, & Zeanah, 2008). ...
Article
Occasional national and international traumas and disasters may affect large numbers of people worldwide. Well-known incidents in the past decade include the death of Princess Diana, the tsunami in South-East Asia, Hurricane Katrina, the Pakistan-Kashmir earthquake, and the World Trade Center terror attack. In all these incidents, in addition to other, less publicized large-scale disasters, hundreds of millions people went through intense emotions of fear, panic, despair, depression, and anxiety. The Internet – through various channels of online communication – provided many of these people with an effective means of psychological relief. Research conducted on such mass traumas has documented the feasibility and effectiveness of Internet-assisted activities in helping people mentally survive the aftermath of such unusual circumstances. This chapter reviews these interesting research reports and identifies specific types and modalities characterizing the online provision of emotional relief. It is proposed to preemptively construct mass disaster-specific web portals that could be operated at times of need and provide numerous effective services. International organizations – such as the UN and its related agencies (e.g., UNICEF, UNESCO), NATO, the World Bank, the European Commission, Interpol, the Red Cross, and the World Health Organization – should consider the initiation and establishment of such institutionalized infrastructures to harness the Internet's ability to meet a population's psychological needs in the event of unpredicted mass-disaster incidents.
... while the model points to all the many potential negative influences on youths' emotional development, it also helps to show that there are just as many areas for intervention. Applying the extant empirical knowledge within the model presented to the realm of policy (Drury, Scheeringa, & Zeanah, 2008;Osofsky, Osofsky, & Harris, 2007) suggests that efforts to prevent and minimize suffering in the wake of disaster will benefit from addressing these multiple levels of impact with interventions in each of the ecologies. From a developmental perspective, much has been learned about the cross sectional linkages between factors thought to influence emotional development. ...
Chapter
This chapter provides an overview of research conducted on the impact of disasters, focusing on the development of childhood and adolescent emotional and behavioral problems. Research suggests that exposure to both human caused and natural disasters is associated with a number of post-traumatic stress reactions in youth including symptoms of several mental disorders. Research findings are reviewed in the chapter within an integrative perspective drawn from contextual/ecological theories of human development. The chapter focuses primarily on research with natural disasters but research from other disasters (e.g., the terrorist attacks of 9/11) are also utilized. It is important to note that effective interventions are available to youth experiencing mental health difficulties following disaster. Cognitive behavioral therapies (CBT) have extensive empirical support. CBT interventions are typically exposure-based, and include various additional specific techniques such as psychoeducation, cognitive coping strategies, and relapse prevention.
... Following trauma exposure, a significant subset of children develop difficulties that are of public health concern including posttraumatic stress disorder (PTSD), anxiety and mood disorders, substance use, and behavioral and interpersonal problems (Ackerman, Newton, McPherson, Jones, & Dykman, 1998;Cicchetti & Toth, 1995;Copeland, Keeler, Angold, & Costello, 2007;Putnam, 2003). As these symptoms are unlikely to remit if untreated (Scheeringa & Zeanah, 2008), it is paramount to intervene with these children. Fortunately, there are a variety of evidence-based trauma-focused treatments for children exposed to traumatic events (Cohen, Mannarino, & Deblinger, 2006;Jaycox, 2003;Scheeringa, Zeanah, Myers, & Putnam, 2005). ...
Article
Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3-18; M=9.97, SD=3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children's caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented.
Chapter
Hurricane Katrina struck the southern coast of the United States on August 31, 2005. This Category 5 hurricane was one of the worst disasters in American history. Here, we review the background and context of Katrina, the costliest ($125 billion) hurricane to ever hit the United States, emphasizing the complex series of traumatic events encompassed by the storm and its aftermath. In particular, we focus on the complicated experiences faced by Katrina-exposed children and their families and review follow-up research on Katrina’s effects on children and their caregivers in both New Orleans, Louisiana, and the coastal Mississippi area. These populations demonstrated high rates of psychopathology, especially PTSD, in the aftermath of the hurricane. We consider findings regarding risk and protective factors and conclude by discussing lessons learned and future directions in disaster preparedness, policy planning, recovery efforts, and treatment interventions.
Article
Disasters can impact upon individuals, families, and communities in multiple ways. Research has mainly focused on risk and protective factors relating to the child (individual level) and the family (interpersonal level), not taking into account the processes at the level of social groups. The present review aims to (a) review psychological research on disasters determined by natural events in childhood, (b) distinguish individual, interpersonal, group, and intergroup levels, (c) emphasize the importance of considering resilience as a key outcome. We reviewed 294 studies (in addition to 28 reviews‐meta‐analyses, and 29 naturalistic interventions), and identified factors at the individual (e.g., demographics, exposure, individual differences), interpersonal (e.g., parent–child relationship, family and school environment), group (e.g., social identity, group membership), and intergroup (relations between different groups) levels. We argue that an integrated model of these factors and their interplay is needed to design interventions to enhance resilience in children and their communities. We extend previous theorizations by providing a wider conceptualization of distress and resilience, and by considering the interplay between factors at different levels. A multidimensional approach to the consequences of disasters in children is crucial to understand their development and well‐being, and to design effective interventions. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.
Article
It has been estimated that as many as two-thirds of American youth experience a potentially life-threatening event before 18 years of age and that half have experienced multiple potentially traumatic events. Race, ethnicity, and culture influence the frequency and nature of these traumas and also the ways in which children react to traumatic events. The authors discuss the varied influences of cultural background on these reactions to trauma, the varying presentations of diverse children experiencing troubling reactions, and the need to provide treatment to children and their families in a fashion that is culturally sensitive and acceptable to diverse families.
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Meta-analyze the literature on posttraumatic stress (PTS) symptoms in youths post-disaster. Meta-analytic synthesis of the literature (k = 96 studies; Ntotal = 74,154) summarizing the magnitude of associations between disasters and youth PTS, and key factors associated with variations in the magnitude of these associations. We included peer-reviewed studies published prior to 1/1/2009 that quantitatively examined youth PTS (≤ 18 years at event) after a distinct and identifiable disaster. Despite variability across studies, disasters had a significant effect on youth PTS (small-to-medium magnitude; rpooled = .19, SEr = .03; d = 0.4). Female gender (rpooled = .14), higher death toll (disasters of death toll ≤ 25: rpooled = .09; vs. disasters with ≥ 1,000 deaths: rpooled = .22), child proximity (rpooled = .33), personal loss (rpooled = .16), perceived threat (rpooled = .34), and distress (rpooled = .38) at time of event were each associated with increased PTS. Studies conducted within 1 year post-disaster, studies that used established measures, and studies that relied on child-report data identified a significant effect. Youths are vulnerable to appreciable PTS after disaster, with pre-existing child characteristics, aspects of the disaster experience, and study methodology each associated with variations in the effect magnitude. Findings underscore the importance of measurement considerations in post-disaster research. Areas in need of research include the long-term impact of disasters, disaster-related media exposure, prior trauma and psychopathology, social support, ethnicity/race, prejudice, parental psychopathology, and the effects of disasters in developing regions of the world. Policy and clinical implications are discussed.
Article
Findings from studies of predominately school-aged children indicate that few children complete trauma-focused treatment; however, researchers have not specifically examined risk factors for dropout among young trauma-exposed children. The purpose of the present study was to investigate risk factors for attrition among young children receiving trauma-focused therapy. Study participants were 189 treatment-seeking children aged 3-5 years (M = 4.86 years, SD = 0.71; 54.1% female, 47.7% White) and their nonoffending legal guardian(s). Child and family characteristics, number of traumatic events, and pretreatment posttraumatic stress symptoms (PTSS) were examined in relation to two attrition definitions: (a) clinician-rated dropout and (b) whether the child received an adequate treatment dose (i.e., 12 or more sessions). Although 70.3% of children prematurely terminated therapy per their clinician, a nearly equivalent portion (67.4%) received an adequate treatment dose. Family characteristics were largely not associated with attrition, although residing farther from the clinic was related to clinician-rated treatment dropout, OR = 0.96. As expected, higher levels of externalizing symptoms were associated with clinician-rated dropout and inadequate dose status, ORs = .95 and .96, respectively, whereas lower levels of trauma-related anger were related to clinician-rated treatment completion, OR = 1.03, and lower levels of PTSS and sexual concerns corresponded with an increased likelihood the child received an inadequate treatment dose, ORs = 1.03 and 1.02, respectively. Thus, child and family factors appear to play a small role in predicting attrition; however, higher levels of externalizing problems and lower levels of PTSS may increase the risk for dropout.
Article
This study describes a videovoice project implemented in post-Katrina New Orleans during a pivotal time in city rebuilding and revitalization. Videovoice is a health advocacy, promotion, and research method through which people get behind video cameras to research issues of concern, communicate their knowledge, and advocate for change. Using videovoice method, a community-academic-filmmaker partnership engaged 10 Central City neighbors, who took part in an 18-week training and community assessment. The resulting 22-min film premiered before more than 200 city leaders and residents, reached more than 4,000 YouTube viewers during its first 2 months online, and was shared through the distribution of 1,000 DVDs. Viewing further helped mobilize the community for action on three priority issues: affordable housing, education, and economic development. Challenges in using videovoice, including privacy issues and cost considerations in a resource-poor community, are discussed. Despite such challenges, this method may provide community-academic partnerships with the opportunity to equitably engage in research, produce independent media, and mobilize for action.
Article
Premature termination from child trauma-focused treatment is common; however, the role of children's level of symptoms as a risk factor for attrition remains uncertain. In particular, children's sexual behavior problems (SBPs) have received scant attention in the prior attrition literature, and no known studies to date have thoroughly examined SBPs in relation to premature treatment termination. The current study investigated whether higher levels of children's SBPs were associated with increased risk for attrition from trauma-focused treatment in a sample of 242 sexually abused children aged 2-12 years (M = 7.48 years, SD = 2.68; 64.5% female, 54.1% White). To assess the potential associations between SBPs and treatment dropout more thoroughly, two definitions of attrition were utilized: (a) clinician-rated dropout and (b) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Whereas only 34.3% of the children completed treatment per their clinician, 69.4% received an adequate dose of treatment. In contrast to the study hypotheses, neither development-related nor sexual abuse-specific SBPs were associated with either clinician-rated dropout or adequate dose status, ORs = 0.99-1.00. Sexual acting-out behaviors in sexually abused children may not correspond with attrition from trauma-focused treatment at multiple points of treatment. Given the heterogeneity of SBPs, further assessment of whether attrition patterns differ across subgroups of children who exhibit SBPs is needed.
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In spring 2009, students in six New Orleans public high schools were surveyed in order to evaluate the effectiveness of School Based Health Centers (SBHCs) in increasing access to and utilization of essential health services, promoting healthy lifestyles, and facilitating good decision-making skills in a complex urban environment. A quasi-experimental research design was utilized, involving three intervention schools with SBHCs and three comparison schools slated to eventually contain SBHCs. Propensity score matching was used to estimate the effects of SBHCs on indicators of adolescent utilization of health services and risky behaviors. Results indicate that adolescents with access to SBHCs report higher rates of utilization of essential health services, particularly vital mental health services, but they are also less likely to engage in behaviors that put their health at risk, including drug use, risky sexual activity, violence, smoking, unhealthy eating habits and lack of exercise. Sensitivity testing using Rosenbaum bounds confirms that the results are relatively insensitive to selection bias arising from unobservable school- or student-level confounders.
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Recent evaluations of school choice school reforms have focused on improving academic achievement but have ignored associations with adolescent health and the risk of interpersonal violence. The innovative school choice model implemented in post-Katrina New Orleans provides a unique opportunity to examine these effects. Using a sample of approximately 1700 students from the 2009 School Health Connection Survey, the relationships between the type of school attended and depression, suicide planning, absences attributable to fears for personal safety, and threats of violence at school are examined. Multivariate regression analysis adjusting for self-selection into the type of school attended-a city-run high-performing school, a state-run failing school, or an independent charter school-estimates the effects of school type on student health. Relative to students at state-run schools, students who choose to attend city-run schools are less likely to plan for suicide or to miss school because they are afraid of becoming victims of violence. These beneficial effects tend to be larger for students traveling from higher violence neighborhoods. The effects for charter schools are similar but less robust. Local school jurisdictions that implement reforms allowing adolescents and their families greater freedom in school choice may also improve adolescent health.
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The COVID-19 forced shutdown of Jewish preschools (Spring, 2020) presented an unprecedented challenge for schools, preschoolers, and their families. During the preschool years, children are vulnerable to trauma, potentially affecting later adjustment. Relationships between school offerings, preschoolers’ school engagement and psychosocial outcomes were explored. Teacher immediacy behaviors were associated with preschoolers’ engagement in online learning but not with psychosocial outcomes. There were correlations between students’ willingness to engage and actual participation in online education and psychosocial adjustment. This study highlights the role that teachers and schools may play in keeping students connected and engaged in school during times of crisis.
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Working within a series of partnerships among an academic health center, local health departments (LHDs), and faith-based organizations (FBOs), we validated companion interventions to address community mental health planning and response challenges in public health emergency preparedness. We implemented the project within the framework of an enhanced logic model and employed a multi-cohort, pre-test/post-test design to assess the outcomes of 1-day workshops in psychological first aid (PFA) and guided preparedness planning (GPP). The workshops were delivered to urban and rural communities in eastern and midwestern regions of the United States. Intervention effectiveness was based on changes in relevant knowledge, skills, and attitudes (KSAs) and on several behavioral indexes. Significant improvements were observed in self-reported and objectively measured KSAs across all cohorts. Additionally, GPP teams proved capable of producing quality drafts of basic community disaster plans in 1 day, and PFA trainees confirmed upon follow-up that their training proved useful in real-world trauma contexts. We documented examples of policy and practice changes at the levels of local and state health departments. Given appropriate guidance, LHDs and FBOs can implement an effective and potentially scalable model for promoting disaster mental health preparedness and community resilience, with implications for positive translational impact.(Disaster Med Public Health Preparedness. 2014;0:1-16).
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The City of New Orleans is located in the Orleans Parish (similar to a county) in the southern part of the State of Louisiana, the United States. The city straddles the end of the Mississippi River just before its confluence with the Gulf of Mexico. Owing to its geographic proximity to the ocean and the Mississippi River, which provides access to the center of the United States, it has been a major port town since the French founded it in 1718. Since then, its unique architecture, history, and celebrations, such as Mardi Gras and Jazz Fest, have made it a tourist destination. Also bringing notoriety to New Orleans was the catastrophic class 2 tropical typhoon named Hurricane Katrina that ravaged the city on August 25, 2005. This natural disaster raised many questions about the government’s involvement in the construction and maintenance of the safety precautions/systems that could have helped save the city and how it was/is involved in the reconstruction of the city. Racial and socioeconomic situations have been at the heart of many of these questions.
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Hurricane Katrina dramatically altered the level of social and environmental stressors for the residents of the New Orleans area. The Family Stress Model describes a process whereby felt financial strain undermines parents' mental health, the quality of family relationships, and child adjustment. Our study considered the extent to which the Family Stress Model explained toddler-aged adjustment among Hurricane Katrina affected and nonaffected families. Two groups of very low-income mothers and their 2-year-old children participated (pre-Katrina, n = 55; post-Katrina, n = 47). Consistent with the Family Stress Model, financial strain and neighborhood violence were associated with higher levels of mothers' depressed mood; depressed mood was linked to less parenting efficacy. Poor parenting efficacy was associated to more child internalizing and externalizing problems.
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This study examined posttraumatic stress disorder (PTSD) and comorbid disorders in 70 preschool children (ages 3-6) and their caregivers following Hurricane Katrina. Children's rate of PTSD was 50.0% using age-modified criteria. The rate of PTSD was 62.5% for those who stayed in the city and 43.5% in those who evacuated. Of those with PTSD, 88.6% had at least one comorbid disorder, with oppositional defiant disorder and separation anxiety disorder being most common. Caregivers' rate of PTSD was 35.6%, of which 47.6% was new post-Katrina. No children and only 2 caregivers developed new non-PTSD disorders in the absence of new PTSD symptoms. Differences by race and gender were largely nonsignificant. Children's new PTSD symptoms correlated more strongly to caregivers with new symptoms compared to caregivers with old or no symptoms.
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SYNOPSIS Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1·30 and 0·44 % respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric co-morbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.
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Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
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We have described a program that integrates clinical approaches of infant mental health to infants and toddlers in foster care. The juxtaposition of a mental health program in a forensic setting creates a number of special features that we have highlighted. Unique from the clinical perspective, the team is explicitly relationship-focused, attempting to understand all of the young child's caregiving relationships as they affect development. We strive to enhance the quality of all of relationships in which infants participate, fostering healthy attachments and development. Also unique is the emphasis on system liaison, and making programmatic efforts to affect various systems involved in making custody determinations about infants and toddlers. Unique from the forensic perspective, we offer multidisciplinary expertise about an especially high-risk population, a comprehensive service delivery system in which we provide or coordinate and monitor all intervention efforts for a given family, a prevention orientation, and clinical follow-up with infants for as long as they are in care. The goals of the program include expediting permanency planning decisions, increasing continuity in high-quality foster care placements, increasing court satisfaction with mental health consultation, decreasing the number of court-ordered evaluations for adjudicated families, and increasing CPS satisfaction with available treatment and continuity of care. We believe that this approach integrates delivery of services to the youngest and most vulnerable victims of maltreatment and expedites permanency planning.
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To examine the lifetime prevalence of trauma experiences and post-traumatic stress disorder (PTSD). Questionnaire-assessed PTSD, the type of traumatic event experienced, perceived trauma impact, and trauma frequency in 1824 randomly selected men and women. PTSD lifetime prevalence was estimated at 5.6% with a 1 : 2 male-to-female ratio, in spite of men reporting greater trauma exposure. The highest PTSD risk was associated with sexual and physical assault, robbery and multiple trauma experiences. Controlling for trauma type did not account for gender differences, while controlling for experienced distress did. The conditional probability for PTSD varied as a function of trauma type, frequency and impact of the event, with increased rates associated with prevalent trauma exposure and higher perceived distress. The latter accounted for the gender effect, suggesting that gender differences in PTSD in part represent a generally greater vulnerability to stress in women.
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Hurricane Katrina was the most devastating natural disaster in US history. Large parts of New Orleans and nearby Louisiana parishes were destroyed. About 90 000 square miles of the Gulf Coast, an area roughly the size of Great Britain, was declared a federal disaster area. The often contaminated flood waters covering much of New Orleans for almost 2 months contained a mix of raw sewage, bacteria, millions of gallons of oil, heavy metals, pesticides, and toxic chemicals, raising health concerns for residents and cleanup workers.
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On the basis of theory and previous research, it was hypothesized that predisaster child trait anxiety would predict disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, even after controlling for the number of hurricane exposure events. Results support this hypothesis and further indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms. Also, Katrina-related posttraumatic stress disorder symptoms were predicted by the number of hurricane exposure events and sex (being female). Predisaster generalized anxiety disorder symptoms predicted postdisaster generalized anxiety disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms. Findings are discussed in terms of their relevance for developing interventions to mitigate the impact of disasters in youths.
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The authors examined the disruption of ongoing treatments among individuals with preexisting mental disorders and the failure to initiate treatment among individuals with new-onset mental disorders in the aftermath of Hurricane Katrina. English-speaking adult Katrina survivors (N=1,043) responded to a telephone survey administered between January and March of 2006. The survey assessed posthurricane treatment of emotional problems and barriers to treatment among respondents with preexisting mental disorders as well as those with new-onset disorders posthurricane. Among respondents with preexisting mental disorders who reported using mental health services in the year before the hurricane, 22.9% experienced reduction in or termination of treatment after Katrina. Among those respondents without preexisting mental disorders who developed new-onset disorders after the hurricane, 18.5% received some form of treatment for emotional problems. Reasons for failing to continue treatment among preexisting cases primarily involved structural barriers to treatment, while reasons for failing to seek treatment among new-onset cases primarily involved low perceived need for treatment. The majority (64.5%) of respondents receiving treatment post-Katrina were treated by general medical providers and received medication but no psychotherapy. Treatment of new-onset cases was positively related to age and income, while continued treatment of preexisting cases was positively related to race/ethnicity (non-Hispanic whites) and having health insurance. Many Hurricane Katrina survivors with mental disorders experienced unmet treatment needs, including frequent disruptions of existing care and widespread failure to initiate treatment for new-onset disorders. Future disaster management plans should anticipate both types of treatment needs.
Article
Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Article
Examined the effects of the 1985 Puerto Rico floods on mental health symptoms and diagnoses and determined the extent to which this effect was influenced by either demographic characteristics or previous symptoms. 912 persons (aged 17–68 yrs) were administered the Spanish version of the Diagnostic Interview Schedule: National Institute of Mental Health. The onset of depression, generalized anxiety, and posttraumatic stress disorder (PTSD) was significantly more common among those exposed to a disaster than among those not exposed. The increase in stress-related disorders in the exposed Ss indicates that disaster stress increased the mental morbidity of this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This study examined the relationships between trait anxiety and anxiety sensitivity and the outcome variables posttraumatic stress disorder (PTSD) symptoms and somatic complaints following a major hurricane. Sixth and seventh graders in the New Orleans area (N = 302) were surveyed 5 to 8 months following Hurricane Katrina. As expected, hurricane exposure was a significant predictor of PTSD symptoms and somatic symptoms. Also as hypothesized, certain factors of anxiety sensitivity interacted with trait anxiety to predict PTSD symptoms and somatic symptoms. Clinical implications of potential linkages among trait anxiety, dimensions of anxiety sensitivity and PTSD, and somatic symptoms are discussed.
Article
This longitudinal study examined the prevalence of posttraumatic phenomena and how they relate to symptomatic and behavioral disorders in a population of schoolchildren exposed to an Australian bushfire disaster. The prevalence of these phenomena did not change over an 18-month period, suggesting that they were markers of significant developmental trauma. The mothers' responses to the disaster were better predictors of the presence of posttraumatic phenomena in children than the children's direct exposure to the disaster. Both the experience of intrusive memories by the mothers and a changed pattern of parenting seemed to account for this relationship.
Article
There have been numerous studies of post-traumatic stress disorder in trauma victims, war veterans, and residents of communities exposed to disaster. Epidemiologic studies of this syndrome in the general population are rare but add an important perspective to our understanding of it. We report findings on the epidemiology of post-traumatic stress disorder in 2493 participants examined as part of a nationwide general-population survey of psychiatric disorders. The prevalence of a history of post-traumatic stress disorder was 1 percent in the total population, about 3.5 percent in civilians exposed to physical attack and in Vietnam veterans who were not wounded, and 20 percent in veterans wounded in Vietnam. Post-traumatic stress disorder was associated with a variety of other adult psychiatric disorders. Behavioral problems before the age of 15 predicted adult exposure to physical attack and (among Vietnam veterans) to combat, as well as the development of post-traumatic stress disorder among those so exposed. Although some symptoms of post-traumatic stress disorder, such as hyperalertness and sleep disturbances, occurred commonly in the general population, the full syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition, was common only among veterans wounded in Vietnam.
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To explore the 21-month course of posttraumatic stress symptomatology (PTSS) and psychological morbidity in 30 school-age children (7 to 13 years) after exposure to Hurricane Andrew. Pynoos' Posttraumatic Stress Disorder Reaction Index and Achenbach's Teacher's Report Form were administered at 8 and 21 months after Hurricane Andrew. At 21 months 70% of the children endorsed moderate-severe PTSS. The reduction in PTSS was greater for boys than girls. Psychopathology as measured by the Teacher's Report Form increased over the 19-month period. Boys demonstrated significant increases in internalizing symptoms and in Withdrawn, Anxious/Depressed, Social Problems, and Attention Problems scales, and girls showed a significant increase in the Anxious/Depressed scale. Twenty-one months after exposure to Hurricane Andrew, there were continuing high levels of PTSS and evidence of increasing emotional and behavioral problems. While girls sustained higher levels of PTSS, boys demonstrated higher indices of other psychopathology. The enduring effects of disaster associated with secondary stressors and "traumatic reminders" continue to be etiologically important for continuing psychological morbidity.
Article
To determine the effectiveness of an intervention designed to improve outcomes for infants and toddlers in foster care. Records were reviewed for all children who were adjudicated as in need of care in a specific parish in Louisiana between 1991 and 1998. This period included 4 years before and 4 years after a comprehensive intervention was implemented. Children adjudicated between 1991 and 1994 were the comparison group, and those adjudicated between 1995 and 1998 were the intervention group. After the intervention, more children were freed for adoption and fewer children were returned to their birth families than before the intervention. There was no difference in length of time in care before and after the intervention. With regard to the same child returning in a subsequent incident of maltreatment, relative risk reduction for the intervention group ranged from 53% to 68%. With regard to the same mother maltreating another child subsequently, relative risk reduction for the intervention group ranged from 63% to 75%. A comprehensive preventive intervention for maltreated infants and toddlers in foster care substantially reduced rates of recidivism but had no effect on length of time in care.
Article
This article describes current approaches to the pharmacologic treatment of posttraumatic stress disorder (PTSD) and reviews the classes of pharmacologic agents used in the treatment of PTSD. Pharmacotherapy for PTSD that is comorbid with other psychiatric disorders is highlighted. The primary-source literature was reviewed by using a MEDLINE search. Secondary-source review articles and chapters were also used. Results from studies of the psychophysiology of PTSD are outlined in the review to help inform treatment choices. The review gives more consideration to controlled studies than to open clinical trials. Recommendations for treatment are evidence based. A growing body of evidence demonstrates the efficacy of pharmacologic treatment for PTSD. The effectiveness of the selective serotonin reuptake inhibitors sertraline and paroxetine in large-scale, well-designed, placebo-controlled trials resulted in their being the first medications to receive approval from the U.S. Food and Drug Administration for the treatment of PTSD. Observation of psychophysiologic alterations associated with PTSD has led to the study of adrenergic-inhibiting agents and mood stabilizers as therapeutic agents. Controlled clinical trials with these classes of medication are needed to determine their efficacy for treating PTSD. Finally, the choice of medication for treating PTSD is often determined by the prominence of specific PTSD symptoms and the pattern of comorbid psychiatric conditions.
Article
To examine the differential efficacy of trauma-focused cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder (PTSD) and related emotional and behavioral problems in children who have suffered sexual abuse. Two hundred twenty-nine 8- to 14-year-old children and their primary caretakers were randomly assigned to the above alternative treatments. These children had significant symptoms of PTSD, with 89% meeting full DSM-IV PTSD diagnostic criteria. More than 90% of these children had experienced traumatic events in addition to sexual abuse. A series analyses of covariance indicated that children assigned to TF-CBT, compared to those assigned to child-centered therapy, demonstrated significantly more improvement with regard to PTSD, depression, behavior problems, shame, and abuse-related attributions. Similarly, parents assigned to TF-CBT showed greater improvement with respect to their own self-reported levels of depression, abuse-specific distress, support of the child, and effective parenting practices. This study adds to the growing evidence supporting the efficacy of TF-CBT with children suffering PTSD as a result of sexual abuse and suggests the efficacy of this treatment for children who have experienced multiple traumas.
Article
The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD. Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined. Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability. The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.
Article
To examine the predictive validity of an alternative to the DSM-IV for diagnosing posttraumatic stress disorder (PTSD) in preschool children and prospectively explore the course of PTSD symptomatology. Sixty-two traumatized children, ages 20 months through 6 years, were assessed three times in 2 years with caregiver diagnostic interviews. PTSD diagnosis at visit 1 significantly predicted degree of functional impairment 1 and 2 years later and predicted PTSD diagnosis 2 years later but not 1 year later. The lack of 1-year diagnostic continuity may be explained by children with new traumas. Unexpectedly, overall PTSD symptoms did not remit over time, regardless of community treatment; however, reexperiencing symptoms decreased and avoidance/numbing symptoms increased with time, with avoidance/numbing symptoms increasing at a faster rate in children with PTSD at visit 1. The previous finding that arousal may cause emotional numbing was not replicated. Significantly more children were functionally impaired at visits 2 (48.9%) and 3 (74.3%) than were diagnosed with PTSD (23.4% and 22.9%, respectively). This study demonstrates predictive validity for the alternative method of diagnosing PTSD in preschool children. The unremitting course of PTSD symptomatology in preschool children and rates of impairment that are higher than rates of diagnosis indicate the need for efficacious treatment.
Article
To shed light on how the public health community can promote the recovery of Hurricane Katrina victims and protect people in future disasters, we examined the experiences of evacuees housed in Houston area shelters 2 weeks after the hurricane. A survey was conducted September 10 through 12, 2005, with 680 randomly selected respondents who were evacuated to Houston from the Gulf Coast as a result of Hurricane Katrina. Interviews were conducted in Red Cross shelters in the greater Houston area. Many evacuees suffered physical and emotional stress during the storm and its aftermath, including going without adequate food and water. In comparison with New Orleans and Louisiana residents overall, disproportionate numbers of this group were African American, had low incomes, and had no health insurance coverage. Many had chronic health conditions and relied heavily on the New Orleans public hospital system, which was destroyed in the storm. Our results highlight the need for better plans for emergency communication and evacuation of low-income and disabled citizens in future disasters and shed light on choices facing policymakers in planning for the long-term health care needs of vulnerable populations.
Article
To examine the test-retest reliability of a new interviewer-based psychiatric diagnostic measure (the Preschool Age Psychiatric Assessment) for use with parents of preschoolers aged 2 to 5 years. A total of 1,073 parents of children attending a large pediatric clinic completed the Child Behavior Checklist 1 1/2-5. For 18 months, 193 parents of high scorers and 114 parents of low scorers were interviewed on two occasions an average of 11 days apart. Estimates of diagnostic reliability were very similar to those obtained from interviews with parents of older children and adults, with kappas ranging from 0.36 to 0.79. Test-retest intraclass correlations for DSM-IV syndrome scale scores ranged from 0.56 to 0.89. There were no significant differences in reliability by age, sex, or race (African American versus non-African American). The Preschool Age Psychiatric Assessment provides a reasonably reliable standardized measure of DSM-IV psychiatric symptoms and disorders in preschoolers for use in both research and clinical service evaluations of preschoolers as young as 2 years old.
Article
Before Hurricane Katrina struck in August 2005, New Orleans had a largely poor and African American population with one of the nation's highest uninsurance rates, and many relied on the Charity Hospital system for care. The aftermath of Katrina devastated the New Orleans health care safety net, entirely changing the city's health care landscape and leaving many without access to care a year after the storm. State and local officials face the challenge of rebuilding and improving the city's health care system by assuring health care coverage for the population and promoting broader access to primary care and community-based health services.
Article
To ascertain whether the differential responses that previously have been found between trauma-focused, cognitive-behavioral therapy (TF-CBT), and child-centered therapy (CCT) for treating posttraumatic stress disorder (PTSD) and related problems in children who had been sexually abused would persist following treatment and to examine potential predictors of treatment outcome. A total of 183 children 8 to 14 years old and their primary caregivers were assessed 6 and 12 months after their posttreatment evaluations. Mixed-model repeated analyses of covariance found that children treated with TF-CBT had significantly fewer symptoms of PTSD and described less shame than the children who had been treated with CCT at both 6 and 12 months. The caregivers who had been treated with TF-CBT also continued to report less severe abuse-specific distress during the follow-up period than those who had been treated with CCT. Multiple traumas and higher levels of depression at pretreatment were positively related to the total number of PTSD symptoms at posttreatment for children assigned to the CCT condition only. Children and caregivers assigned to TF-CBT continued to have fewer symptoms of PTSD, feelings of shame, and abuse-specific parental distress at 6- and 12-month assessments as compared to participants assigned to CCT.
Schools take in displaced students
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